DSAEK
El DSAEK It is a surgical technique of selective transplantation of the cornea. Unlike penetrating transplantation, in which all layers of the cornea (epithelium, Bowman, stroma, Descemet and endothelium) are transplanted, in the DSAEK, only the posterior layers are transplanted, Descemet and Endothelium. This is because not all layers of the cornea are always damaged and therefore, it is not necessary to transplant the entire cornea.
The main advantage is that this selective surgery is more effective and safe and recovery time is much faster.
DSAEK
El DSAEK It is a surgical technique of selective transplantation of the cornea. Unlike penetrating transplantation, in which all layers of the cornea (epithelium, Bowman, stroma, Descemet and endothelium) are transplanted, in the DSAEK, only the posterior layers are transplanted, Descemet and Endothelium. This is because not all layers of the cornea are always damaged and therefore, it is not necessary to transplant the entire cornea.
The main advantage is that this selective surgery is more effective and safe and recovery time is much faster.
What is DSAEK surgery?
The cornea is made up of five layers: epithelium, Bowman's membrane, stroma, Descemet's membrane, and endothelium (from outside to inside).
Surgery DSAEK (Descemet Stripping with Automated Endothelial Keratoplasty) is a surgical technique to address the cornea transplant replacing the two posterior layers of the cornea, the Descemet and the endothelium, which are next to the aqueous humor and the anterior chamber of the eye. The DSAEK technique, like the DMEK, it is also known as selective corneal transplant, Ya que we select the layers of the cornea that we are going to transplant (only damaged ones).
DSAEK is a complex surgery that offers excellent results if done correctly. For this, it is essential to go to a ophthalmological center expert in corneal transplantation, where they have a surgeon who specializes in this type of surgery and who has the experience and technology necessary to carry it out.
Causes for performing a DSAEK
El endothelium It is a layer of cells with a hexagonal and uniform size, which behaves like a semi-permeable membrane and allows the aqueous humor to pass into the cornea, providing nutrients, such as glucose or ions. Its function is maintain a certain degree of hydration in the corneal stroma, which makes it possible for the cornea to be transparent and let light pass into the retina so that we can see.
When endothelial cells are altered, there is a failure in the hydration control of the cornea, it can no longer exert its barrier function and more liquid (aqueous humor) penetrates into the corneal stroma, altering its three-dimensional structure and causing its opacification, a corneal edema occurs .
The main problem is that the endothelium has no regenerative capacity, once the endothelial cells have deteriorated, when it goes from a normal cell density of 3.000 cls / mm2 to less than 500 cls / mm2, the irreversible edema and this is when corneal transplantation should be considered.
Who is the DSAEK suitable for?
This operation is indicated for corneal diseases such as the following:
- Endothelial dystrophies.
- Corneal decompensations due to trauma or interventions (such as Cataracts).
- Keratoconus.
El DSAEK is safer and therefore carries a lower risk of complications than other techniques such as the penetrating corneal transplant, since it is not necessary to transplant the entire cornea. This fact makes the patient require fewer revisions and allows much better control of any possible rejection.
DSAEK surgery step by step
In the case of DSAEK only Descemet's membrane and endothelium are transplanted, without touching the anterior part of the cornea.
The steps that are carried out in the DSAEK are the following:
- A small incision to remove Descemet's membrane and affected endothelium
- Then, from the donor cornea 10-20% containing healthy endothelial cells is removed adhered to its Descemet's membrane, and is introduced into the patient's eye through the incision made in the previous step.
- Now, is placed in the proper position, and an air bubble holds the transplanted tissue in place.
- The patient will have to be one hour in recovery to hold implanted tissue in place.
The difference between DSAEK and penetrating corneal transplantation is remarkable. When performing a conventional, penetrating corneal transplant, a suture with 16-24 stitches is required, which can induce a high degree of astigmatism, hindering the visual recovery of patients. This does not happen with the DSAEK, the astigmatism is minimal and the recovery is faster and more effective, with better visual quality.
Advantages of the DSAEK technique
It is worth highlighting the following advantages in DSAEK technique:
- Endothelial tissue is introduced through a small incision It does not require sutures or only 2-3 stitches, compared to 16-24 stitches for penetrating transplantation.
- Minimal induced astigmatism.
- The patient may be given discharge the same day of the intervention, after a short period of rest (30 min), to verify that the implant is perfectly adhered.
- Recovery time is reduced considerably compared to a penetrating corneal transplant (30 min vs 60-90 min).
- There lower risk of rejection than in the case of penetrating cornea transplantation.
- If there is a rejection, it is a lot easier to replace the affected tissue with that of a new donor.
- Corneal nerves are not damaged, which helps to improve the discomfort of dry eyes and hypersensitivity.
- Lower risk of intraocular infection and expulsive bleeding, since the intervention is carried out in a "closed chamber".
The advantages of this technique derive from the procedure itself, in which it is not required to transplant the entire cornea, but rather replace only the back Of the same. The patient not only recovers before and with less risk of complications, but also does it in a more comfortable and faster than under other corneal transplantation techniques.
En Área Oftalmológica Avanzada we are experts in corneal transplantation using the technique of DSAEK. If you want to answer any questions about this surgery, get in touch with us, we are happy to assist you!
